JUDGES' CERTIFICATE OF ELECTION RETURNS and 
STATEMENT OF BALLOTS 

POLLING PLACE ELECTION
§1-13.5-613, C.R.S.

JUDGES’ CERTIFICATE OF RETURNS:

		IT IS HEREBY CERTIFIED by the undersigned, who conducted the election held in the ________________ District, in                          County, Colorado, on the 3rd day of May, 2022, that after qualifying by swearing and subscribing to their Oaths of Office, they opened the polls at 7:00 a.m., and that they kept the polls open continuously until the hour of 7:00 p.m. on said date, after which they counted the ballots cast for Directors of said District and for any ballot questions duly submitted, 

That the votes cast for Director of the District for a 3-year term were as follows (numeric and spelled out):

CANDIDATE FOR DIRECTOR	VOTES CAST AT POLLING PLACE	ABSENTEE/
UOCAVA VOTES CAST	TOTAL VOTES CAST	

				

				

That the votes cast for Director of the District for a 1-year term were as follows (numeric and spelled out):

CANDIDATE FOR DIRECTOR	VOTES CAST AT POLLING PLACE	ABSENTEE/
UOCAVA VOTES CAST	TOTAL VOTES CAST	

				

*That the votes cast for and against each ballot ballot question submitted were as follows:

____________________________DISTRICT BALLOT QUESTION A 

(insert ballot language text )

	VOTES CAST AT POLLING PLACE	ABSENTEE/
UOCAVA VOTES CAST	TOTAL VOTES CAST	

YES

NO
				
*Delete Section if Not Applicable

It is hereby indentified and specified that:

Number of Ballots Delivered to Electors:
		
Absentee:	                                    			

		UOCAVA:			
		
		Polling Place:	       			             		
		
Total number of ballots delivered to electors:				

Number of Ballots Returned (VOTED)

Absentee:		
                                     			
		UOCAVA:			

		Polling Place	
			
Official:				
			
Unofficial:					

Substitute: 

			Total Number of Ballots Returned (Voted):		

Number of Ballots not Delivered to Electors:				
(Those left over on ballot pads at polling place)	
	
Number of Spoiled Ballots:			
						
			Number of Successfully Challenged Ballots:						
			Number of Defective Ballots (do not include partial):

			Number of Rejected Abstentee & UOCAVA Ballots:		

Certified this 3rd day of May, 2022.    

																			Election Judge	

Election Judge

Election Judge	

THIS IS A SAMPLE TEMPLATE. REVIEW WITH YOUR ATTORNEY.